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Medications that Affect Immune System: Immunizations Ronnie Tunstall, MSN RN  Objectives Describe the action of drugs acting on the immune system Assess for side effects and adverse reactions related to select drugs acting on the im...

Medications that Affect Immune System: Immunizations Ronnie Tunstall, MSN RN  Objectives Describe the action of drugs acting on the immune system Assess for side effects and adverse reactions related to select drugs acting on the immune system. Formulate an appropriate nursing plan of care for a client receiving medications and evaluate acting on the immune system.  ▪ Hepatitis A & Hepatitis B ▪ Diphtheria, Tetanus, & acellular pertussis (DTaP) ▪ Polio ▪ Measles, Mumps, Rubella (MMR) ▪ Haemophilus influenza type B (HiB) RECRECOMMENDED ▪ Pneumococcal conjugate (PCV13) ▪ Inactivated poliovirus IMMUNIZATIONS ▪ Influenza ▪ Varicella ▪ Meningococcal Conjugate Polysaccharide (MCV4) ▪ Human papilloma Vaccine (vHPV)  HEPATITIS A ▪ Virus spread by fecal-oral route and person to person contact (ingestion contaminated food or water) ▪ Abrupt onset: fever, malaise, anorexia, nausea, abdomen pain, dark urine & jaundice ▪ Hep A vaccine (two dose series) is now recommended for all children beginning at age 1 and 2nd dose NO earlier than 6 months after first administrations HEPATITIS B ▪ In pediatrics this disease can lead to fatal consequences from cirrhosis or liver cancer during adulthood. ▪ Transmitted from person to person via blood, semen, or other body fluids ▪ Education on importance of immunization while in the hospital along with series of immunizations (3 doses) at one, two, and six months of age ▪ Site of injection: vastus lateralis (IM) newborns or deltoid for older infants/children. No matter the age avoid dorsogluteal site bc linked low antibody seroconversion rates DIPHTHERIA, TETANUS, & PERTUSSIS (DTaP) Diphtheria: thick covering in the back of the throat ▪ Can lead to difficulty breathing, heart failure, paralysis, and death Tetanus: “lockjaw” ▪ Generalized muscle stiffness Pertussis: whooping cough ▪ Uncontrollable, violent coughing ▪ Increased difficulty breathing ▪ Can be deadly for babies  ▪ Indication: Recommended for the prevention of diphtheria, tetanus, and pertussis ▪ Adverse reactions: fever, site irritation, and soreness at injection site. Rare: seizures and change in LOC ▪ Nursing interventions: Determination if children can DTAP VACCINE get vaccination or if vaccination is contraindicated at that time. ▪ Site of injection: vastus lateralis (IM) ▪ FIVE doses: 2 months, 4 months, 6 months, 15- 18MONTHS, 4-6YEARS Meningococcal Conjugate Polysaccharide (MCV4): ▪ Administer to students up to age 21 years entering college and living in dormitories if not received at age 16, military recruits and those traveling or living in areas of epidemic rates of meningococcal disease ▪ Reimmunization every 5 years for adults who remain at high risk for infection ▪ Human papilloma Vaccine (vHPV): ▪ Adverse Effects redness, swelling tenderness at site, fever, HA, and fainting (shortly after receiving injection) ▪ Contraindications pregnancy and severe allergy to yeast ▪ Two doses prior to age 16 six months to 12 months apart of injections. If administered after age 16, 3 doses are required POLIO ▪ Disabling and life-threatening disease caused by the poliovirus that spreads from person to person ▪ S/S loss of reflexes, severe muscle aches or weakness & flaccid paralysis POLIO INACTIVATED POLIOVIRUS (IPV) VACCINE ▪ Evaluate if the patient is sick (may need to reschedule vaccination) ▪ Four doses: 2 months, 4 months, 6 to 18 months, and 4 to 6 years of age ▪ Administered IM or subcutaneous route (depends on age and doctor order) Measles, Mumps, & Rubella (MMR) Measles: fever, cough, runny nose, and is commonly followed by a rash Mumps: virus can lead to meningitis, deafness, and painful swelling of testes or ovaries Rubella: (German measles) Can cause arthritis in up to half of teenage and adult women. Can cause miscarriage if female is pregnant. Adverse reactions Not given to pregnant women. Soreness, swelling, seizures, low platelet count,rash, and deafness (rare). Educate women not to receive while pregnant or 28 days after receiving vaccination. Contradiction -Anaphylactic reactions to gelatin or neomycin Site of injection: subcutaneously Children: small- anterolateral aspect of thigh. Older children- posterior triceps Two doses : 12-15MONTHS AND 4-6YRS OF AGE Adults: posterior triceps (may require one more dose) Pneumococcal Infections ▪ Bacteria commonly causes pneumonia ▪ Identification of individuals at risk for contracting the pneumococcal bacteria is vital can lead to meningitis PCV13 VACCINE ▪ Indication: Protection against pneumococcal disease (13 types). ▪ Adverse reactions: fainting, soreness at injection site, severe allergic reactions are rare ▪ Recommended for adults who are immunocompromised, have certain chronic diseases, smoke cigarettes or live in long term care facilities ▪ Nursing interventions: Proper location of injection site, education to at risk populations, determination of size and length of needle. ▪ Site of injection: Infants and young children:VASTUS LATERALIS ▪ Older children and adults: DELTOID ▪ Four doses: 2 months, 4 months, 6 months, & 12-15 MONTHS OF AGE Haemophilus Influenza Type B ▪ Virus that results in a range of infections: ear infections, serious bloodstream infections, pneumonia, meningitis ▪ Can result in brain damage, hearing loss, or death ▪ Adverse reaction fever, nausea/vomiting/diarrhea ▪ Contradictions less than 6 weeks of age HIB VACCINE ▪ Protection against numerous serious infections caused by H. influenza type B ▪ Adverse reactions: irritation at injection site, fever, and fainting ▪ Site of injection: vastus lateralis (IM) ▪ Three or four doses depending on vaccine ▪ Doses administered at TWO MONTHS, 4 MONTHS, 6 MONTHS, 12- 15 MONTHS OF AGE  Rotavirus ▪ Adverse Effects- irritability, mild, temporary diarrhea or vomiting ▪ Contraindication – history of intussusception (the inversion one portion of the intestine within another) and severe combined immunodeficiency (SCID) rare inherited disorder ▪ Precautions – spina bifida, bladder exstrophy (bladder develops outside of fetus) or chronic GI disease  INFLUENZA ▪ Influenza is a potentially serious contagious respiratory illness ▪ Children can start receiving the inactivated influenza vaccine at 6 months ▪ Pregnant women can get seriously ill from the flu because of changes in immune, heart and lung function INFLUENZA VACCINE Influenza ▪ Adverse reactions: mild – same as all other vaccines. More severe: Guillian-Barre Syndrome (nerve cell damage- paralysis), seizures, acute encephalopathy Site of injection: ▪ Children: vastus lateralis (IM) 6 months to 8 years old may be given in 2 doses 4 weeks apart ▪ Older children and adults: deltoid (IM) ▪ Nasally is live virus and two does at least 28 days apart for healthy people 2 to 49-year-old, but not recommended in 2 to 4 years with wheezing within one year or patients with asthma ▪ Vaccine should be given annually  VARICELLA ▪ Can be serious and even life-threatening to individuals with weakened immune systems, babies, and adults. ▪ S/S: fatigue, fever, itchy rash blisters VARICELLA VACCINE ▪ Prevent against contracting “chickenpox” if patient has not had the infection or is not a reliable historian. ▪ Adverse reactions: soreness and irritation. Uncommon: rash, seizure, meningitis, and pneumonia. ▪ Obtain adequate history on patient’s exposure or vaccination history. ▪ Site of injection: SUBCUTANEOUS. Posterior tricep ▪ Children (12mo-12yrs): 2 doses at 12 to 15 months and 4 to 6 years ▪ 13yr + : 2 doses at 28 days apart  Immunizations Precautions, Complications and Contraindications ▪ Anaphylactic reactions to a vaccine is contraindication for further doses of that vaccine ▪ Anaphylactic reaction to any component of a vaccine is contraindicated ▪ Do not administer live virus vaccines (varicella or MMR) to patients who is severely immunocompromised. Severe febrile illness is contraindicated for all vaccines ▪ Moderate or severe illness with or without fever are precautions to receiving immunizations ▪ Common cold and other MINOR illnesses are note contraindication or precaution for receiving immunizations. ▪ Scan QR code to view what a Vaccine Information Sheets (VIS) that are provided to patients or parents after immunizations are administered ▪ Nurses must document that this was provided to patients or parents and the date of VIS form that is at end of sheet